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NPI Code Detail

MEDICARE: DR. JAY PAUL LIZYNESS OD

MEDICARE: DR. JAY PAUL LIZYNESS OD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1152W00000XOptometristL698050MI

General Provider Information

NPI Number : 1629093562
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JAY PAUL LIZYNESS OD
Provider Business Mailing Address
First Line : 2799 W GRAND BLVD
Second Line :
City : DETROIT
State : MI
Zip : 48202-2608
Country : US
Telephone Number : 313-916-3226
Fax Number : 313-916-8132
Provider Business Practice Location Address
First Line : 655 W 13 MILE RD
Second Line :
City : MADISON HEIGHTS
State : MI
Zip : 48071-1844
Country : US
Telephone Number : 248-577-3659
Fax Number : 248-588-9320
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/13/2006
Last Update Date : 03/11/2014

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Directions to “ DR. JAY PAUL LIZYNESS OD” Practice Location

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